What is fluoxetine (Prozac)? 

Fluoxetine is an antidepressant in a group  of drugs called selective serotonin reuptake inhibitors (SSRIs). Fluoxetine affects chemicals in the brain that may become unbalanced  and cause depression, panic, anxiety,  or obsessive-compulsive symptoms. 

Fluoxetine is used  to treat major depressive disorder, bulimia nervosa (an eating disorder) obsessive-compulsive disorder, panic disorder,  and premenstrual dysphoric disorder (PMDD). 

Fluoxetine is sometimes used together with another medication called olanzapine (Zyprexa)  to treat depression caused by bipolar disorder (manic depression). This combination is also used to treat depression after at least 2  other medications have been tried without successful treatment of symptoms. 

Fluoxetine  may also be used for purposes other  than those listed in this medication guide.
Important information about fluoxetine 

Do  not take fluoxetine together with pimozide (Orap), thioridazine (Mellaril), or  a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam),  or tranylcypromine (Parnate). 

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Your doctor will need to check you  at regular visits for at least  the first 12 weeks  of treatment. 

Call  your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping,  or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally  or physically), more depressed,  or have thoughts about suicide  or hurting yourself. SSRI antidepressants may cause serious or life-threatening lung problems in newborn babies whose mothers take  the medication during pregnancy. However,  you may have a relapse of depression if you stop taking  your antidepressant during pregnancy. If  you are planning a pregnancy, or if  you become pregnant while  taking fluoxetine, do not stop taking  the medication without first talking  to your doctor.

Before taking fluoxetine 

Do not use fluoxetine  if you are using  any of  the following drugs: 

• pimozide (Orap); 
• thioridazine (Mellaril); or 
• an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), rasagiline (Azilect),  or selegiline (Eldepryl, Emsam). 
• Serious  and sometimes fatal reactions can occur when these medicines are taken  with fluoxetine. You must wait at least 14 days after stopping  an MAO inhibitor before you can take fluoxetine. You must wait 5 weeks after stopping fluoxetine before you can take thioridazine (Mellaril)  or an MAOI. 

Before taking fluoxetine, tell  your doctor  if you are allergic  to any drugs, or if you have: 

• cirrhosis of the liver; 
• kidney disease; 
• diabetes;
• seizures or epilepsy; 
• bipolar disorder (manic depression); or
• a history of drug abuse or suicidal thoughts. 

If you have any of these conditions, you may not be able to use fluoxetine, or you may need a dosage adjustment or special tests. 

You may have  thoughts about suicide while taking an antidepressant, such as fluoxetine, especially if you are younger than 24 years old. Tell your doctor if you have worsening depression or suicidal thoughts during  the first several weeks  of treatment, or whenever your dose  is changed. 

Your family or other caregivers  should also  be alert  to changes in your mood  or symptoms. Your doctor will need  to check you at regular visits for at least  the first 12 weeks of treatment. 

FDA pregnancy category C. SSRI antidepressants may cause serious  or life-threatening lung problems in newborn babies whose mothers take  the medication during pregnancy. However, you may have  a relapse  of depression if you stop taking your antidepressant during pregnancy. If you are planning a pregnancy,  or if you become pregnant while taking fluoxetine, do not stop taking  the medication without first talking to  your doctor. Fluoxetine can pass into breast milk  and may harm a nursing baby. Do not use this medication without telling  your doctor if  you are breast-feeding a baby. Do  not give fluoxetine to anyone younger than 18 years old without a doctor's advice. 

How should I take fluoxetine? 

Take fluoxetine exactly as it was prescribed for you.  Do not take the medication in larger amounts,  or take it for longer than recommended by your doctor. Follow the directions on your prescription label. 

Your doctor may occasionally change your  dose to make sure you get the best results from fluoxetine. 

Do not break, chew, or open an extended-release capsule. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking the pill would cause too much  of the drug to be released at one time. 

Measure the liquid form of  fluoxetine with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask  your pharmacist where you can get one. 

It may take 4 weeks or longer before you start feeling better.  Do not stop using fluoxetine without first talking to your doctor. You may have unpleasant side effects if  you stop taking this medication suddenly.

To  treat premenstrual dysphoric  disorder, the usual dose of fluoxetine is once daily while you are having  your period, or 14 days before you expect  your period to start. Follow your doctor's instructions. 

Store fluoxetine at room temperature away from moisture and heat. 

What happens if I miss a dose? 

Take  the missed dose as soon as you remember. However, if  it is almost time for the next regularly scheduled dose, skip the missed dose  and take the next one as directed. Do not take extra medicine to make up the missed dose. 

If you miss a dose  of Prozac Weekly, take the missed dose as soon as you remember  and take  the next dose 7 days later. However, if it  is almost time for the next regularly scheduled weekly dose, skip the missed dose and take the next one as directed.Do not take extra medicine  to make up  the missed dose. 

What happens if I overdose? 

Seek emergency medical attention if you think you have taken too much  of this medication. Overdose may cause nausea, vomiting, fever, sleepiness, rapid or uneven heartbeat, confusion, fainting, seizures, or coma. 

What should I avoid while taking fluoxetine? 

Avoid drinking alcohol, which can increase some  of the side effects  of fluoxetine. Fluoxetine can cause side effects that  may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. 

Fluoxetine side effects 

Get emergency medical help if you have any of these signs of an allergic reaction: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat. 

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself. 

Call your doctor at once if you experience any  of these serious side effects from using fluoxetine : 

• severe blistering, peeling, and red skin rash; 
• very stiff (rigid) muscles, high fever, sweating, fast  or uneven heartbeats, tremors, overactive reflexes; 
• nausea, vomiting, diarrhea, loss of appetite, feeling unsteady, loss of coordination; or 
• headache, trouble concentrating, memory problems, weakness, confusion, hallucinations, fainting, seizure, shallow breathing  or breathing  that stops. 
• Less serious fluoxetine side effects may include: 
• cold symptoms such as stuffy nose, sneezing, sore throat; 
• drowsiness, dizziness, feeling nervous; 
• mild nausea, upset stomach, constipation; 
• increased appetite, weight changes; 
• sleep problems (insomnia); 
• decreased sex drive, impotence, or difficulty having an orgasm; or 
• dry mouth. 

This is not  a complete list  of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA 

What other drugs will affect fluoxetine?

Talk to  your doctor before taking any medicine for pain, arthritis, fever, or swelling. This includes aspirin and NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), diclofenac (Voltaren), indomethacin, piroxicam (Feldene), nabumetone (Relafen), etodolac (Lodine), and others. Taking any of these drugs with fluoxetine may cause you to bruise or bleed easily. 

Tell  your doctor if  you regularly use other medicines that make you sleepy (such as cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures or anxiety). They can add to sleepiness caused by fluoxetine. 

Tell  your doctor about all other medications you are using, especially: 

• alprazolam (Xanax); 
• clopidogrel (Plavix); 
• clozapine (Clozaril, Fazaclo); 
• flecainide (Tambocor); 
• haloperidol (Haldol); 
• seizure medication such as phenytoin (Dilantin) or carbamazepine (Tegretol); 
• tryptophan (also called L-tryptophan); 
• vinblastine (Velban); 
• a blood thinner such as warfarin (Coumadin); 
• almotriptan (Axert), frovatriptan (Frova), sumatriptan (Imitrex), naratriptan (Amerge), rizatriptan (Maxalt), or zolmitriptan (Zomig); or 
• any other antidepressants such as amitriptyline (Elavil), escitalopram (Lexapro), imipramine (Tofranil), sertraline (Zoloft), and others. 

This list is not complete and there may be other drugs that can interact with fluoxetine. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. 

Where can I get more information? 

• Your pharmacist can provide more information about fluoxetine. 

• Every effort has been made to ensure that the information provided is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. 

Notes: FCbinderMD

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EditText of this page (last edited May 1, 2010)